Safety and efficacy of levonorgestrel‐releasing intrauterine device in the treatment of atypical endometrial hyperplasia and early endometrial cancer

Abstract Aim To investigate the recurrence rate, live‐birth rate, and treatment outcomes of levonorgestrel‐releasing intrauterine device (LNG‐IUD) for the management of atypical endometrial hyperplasia (AEH) or Grade‐1 endometrial cancer (EC) in patients who desire fertility‐sparing treatment and those seeking conservative treatment without fertility preservation. Methods We prospectively enrolled nine patients from a single institution between April 2009 and September 2013 who were followed up for 60 months after LNG‐IUD insertion. Results The median patient age was 35 (range: 29–39) years. The overall recurrence rate was 56% (5/9). The median interval between removal of the LNG‐IUD and recurrence was 20.5 (range: 2–30) months. Three of the nine patients had Grade‐1 EC, and six had AEH. The response rates to the LNG‐IUD in patients with Grade‐1 EC and AEH were 66% and 100%, respectively. Four patients (three with AEH, one with Grade‐1 EC) experienced recurrence 6 months after MPA treatment and all 4 (100%) had complete response. Eight patients desired fertility preservation, of which 37% (3/8) conceived after receiving fertility treatment and 25% (2/8) had a live birth; the remaining three had previously received MPA for 6 months and had a recurrence; of these, 1 had a live birth. Conclusion LNG‐IUD is effective for the management of AEH and EC in young patients who desire fertility‐sparing treatment, including those ineligible for MPA owing to the presence of comorbidities and those with recurrence after MPA treatment (6‐month treatment), and patients seeking conservative treatment without fertility preservation.